Basic Information
| Provider Information | |||||||||
| NPI: | 1407818404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 CENTERVILLE RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017374828 | ||||||||
| FaxNumber: | 4017328484 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 CENTERVILLE RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017374828 | ||||||||
| FaxNumber: | 4017328484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 02/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 8359 | RI | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 8359 | RI | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 838-7 | 01 | RI | BCBSRI | OTHER | 004602 | 01 | RI | BCBSRI/CHIP | OTHER | 7003348 | 05 | RI | MEDICAID |